Quality Assurance Auditor
Independent Health
full-time
Posted on:
Location Type: Hybrid
Location: Buffalo • New York • United States
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Salary
💰 $24 - $27 per hour
About the role
- Perform monitoring, oversight, and quality assurance reviews/audits of all lines of business as defined by CMS, NYS DOH, NYS DFS and any/all policies and procedures established (as applicable) for assigned operational areas.
- Ensure the quality and accuracy of the systems and processes that support the organization’s operation to meet client government regulatory requirements and compliance plans.
- Track issues identified during the quality assurance process to ensure resolution.
- Analyze, document, and report on results to business stakeholders and company leaders.
- Collaborate with the Quality Assurance team and other cross functional teams to remediate audit findings, to develop and improve testing and audit strategies, techniques, activities, policies and procedures.
- Conduct internal audits to measure and ensure adherence to claims processing standards, technical requirements, supporting processes, systems, and required program documentation.
- Report quality assurance and audit results to management and leadership teams.
- Perform ad hoc queries in audit database in support of decision making.
Requirements
- High school diploma or GED required.
- Associates degree preferred.
- Three (3) years of experience in quality assurance/quality control, compliance monitoring, pharmaceutical, or managed care environment required.
- Experience with Medicare, Medicaid or another government program strongly preferred.
- Experience with pharmacy on-line claims processing systems preferred.
- Strong analytical, problem solving, time management and organizational skills.
- Ability to use independent judgement and solid reasoning skills when rendering decisions and troubleshooting issues.
- Detail oriented, while maintaining an awareness of overall goals.
- Experience with AS400 query or other query tools.
- Ability to easily learn new software applications.
- Experience in report production.
- Ability to maximize use of system capabilities to lead the organization in outcome improvement.
- Excellent interpersonal, written and verbal communication skills.
- Proven examples of displaying PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.
Benefits
- full range of benefits
- generous paid time off
- scorecard incentive
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quality assurancequality controlcompliance monitoringanalytical skillsproblem solvingreport productionclaims processingquery toolsaudit strategiesdocumentation
Soft Skills
time managementorganizational skillsindependent judgementreasoning skillsdetail orientedinterpersonal skillswritten communicationverbal communicationcollaborationdecision making
Certifications
high school diplomaGEDassociates degree